Urology

As a medical specialty that focuses on the urinary tract of men and women, and also the male’s reproductive system, these doctors are trained to diagnose, treat and manage a wide variety of urological disorders such as problems of the kidneys, adrenal glands, ureters and bladders as well as those of the male reproductive system.

Urology Conditions and Symptoms

Urological condition and symptoms are diverse and can often be misdiagnosed, hence a comprehensive screening is recommended to accurately discern and treat the infection. Your doctor will often ask questions related to your symptoms, conduct a physical exam and finally recommend additional test if deemed necessary.
Kidney Stones

Mineral and salt deposits that form inside your kidneys can harden and become kidney stones. This usually happens when your urine is overly concentrated leading to crystalisation of these mineral and salt deposits. Passing a stone can be painful but kidney stones typically do not cause any harm when discovered early.

However, if they become trapped in the urinary tract they can lead for further complications such as infection.

Though they may not produce any symptoms on their own, you might feel them when they start moving around the kidneys or when they're passed through the ureter. Later symptoms include:

- Severe pain in the side and back, which may radiate towards the legs in waves

- Pain during urination

- Cloudy or foul-smelling urine

- Blood in urine

- Fever

Urinary Incontinence

The loss of bladder control can be a common problem and varies from the occasional leak from a sneeze or cough to a sudden and unbearable urge to urinate.

Urinary incontinence is also not always an inevitable part of ageing because all it takes is a simple lifestyle change or some medical treatment to help address any discomfort or stop incontinence.

Erectile Dysfunction

Referring to the inability for a male to have a firm enough erection for sexual intercourse, erectile dysfunction can be a result of a combination of physical and psychological issues. If persistent, this can also be an underlying sign and risk of diabetes and heart disease.

Do consult your doctor if you have any concerns regarding your erections or if you're experiencing any other sexual issues such as premature or delayed ejaculation.

Benign Prostatic Hyperplasia (BPH)

Commonly experienced by older men, the prostate may be larger than usual thus placing pressure on the urethra. Some may experience weak streams during urination or wake up frequently to use the bathroom. Some specialists may even attribute the cause of enlargement to hormones.

Because the urethra is pinched, ones bladder has to work twice as hard causing the muscles to become weaker over time. Symptoms that may arise care:

- Incontinence

- Increased frequency of urination

- Increased urge to urinate even after urinating

Prostate Cancer

Despite the name, it is a relatively common condition and grows slowly, contained within the prostate in its earlier stages. Most men with this form of cancer may even live for many years without exhibiting any issues.

However, if the tumour begins to spread beyond the prostate it may cause blockages in the surrounding tissues resulting in these symptoms:

- Increased frequency of urination at night

- Difficulty starting or stopping streams

- Incontinence during laughter, coughs and sneezes

- Pinful sensation during urination or ejculation

- Blood in urine or semen

Bladder Cancer

This condition typically occurs when cells in the bladder begin growing quickly and out of control. When enough of these cells develop, they form a tumour which can potentially spread to other parts of the body. Typically, the cancers begins in the urothelium, the innermost lining of the bladder. When it spreads it often first attacks the lymph nodes, liver or lungs.

Symptoms may include:

- Blood in urine

- Loss of appetite followed by weight loss

- Frequent than usual urination

- Pain during urination

- Feeling the urge to urinate even if the bladder isn't full

- Lower back pain on one side

- Weakened urine stream

- Fatigue and weakness

Urinary Tract Infection

When bacteria in one's digestive system comes into contact with the urethra, the microbes may overcome the body's natural defences causing pain and infection. If untreated, there is a potential for the infection to spread to the kidneys making it harder to treat. Anyone is prone to potentially developing a urinary tract infection though they are more common in women.

Symptoms may include:

- Pain in kidneys

- Pelvic pain

- Muscular aches and fatigue

- Pain during urination

- Blood in urine

- Cloudy and strong smelling urine

- Increased urge to urinate

Urological Condition Screening

Most screening tests are useful for those experiencing any of the symptoms above. Because genetics may play a vital role, we advise those who happen to have a family history of frequent urological conditions to undergo screening as soon as symptoms show, as infections only get worse over time. Screening is even more important for those who have persistent and recurring urological issues.

Screenings may include these types of tests:

- Imaging tests like Ultrasound, CT and MRI scans

- Cystoscope inserted via the urinary tract and to take samples of tissue for testing

- Urine tests to check for the presence of bacteria or other signs of a disease

- Biopsies to look for cancers and other disorders

- Urodynamic testing to determine how fast urine leaves the body, volume left behind after and the pressure of the bladder

Diagnosis of Urological Conditions

Your specialist may diagnose several conditions through these methods:

Urinalysis

Your sample of urine will be sent to the lb for analysis and any indicators of infection such as high white blood cell count and bacteria will be noted. In order to reduce contamination of your sample, you may be instructed to clean your genital area and only collect urine mid stream.

Urine Culture

The growth of a bacterial culture under laboratory conditions may be used together with urinalysis. This test may help detect the strain of bacteria causing your infection thus allowing your specialist to determine the appropriate course of treatment.

Ultrasound, CT Scan, MRI

Image capturing tests such as Ultrasounds, CT Scans and MRIs may be used in patients who experience persistent and/or frequent infections. These allow your specialist to assess if your urinary tract has any signs of abnormality. A contrast dye may sometimes be used before imaging tests to help highlight the structures of the urinary tract.

Cystoscopy

When severe and recurrent infections occur, a cystoscopy may be recommended where a lens on a thin, long tube allows for a clearer and more detailed examination of the urethra and bladder.

Treatment for Various Urological Conditions

Though antibiotics or antimicrobials may do the trick by killing infection causing bacteria, different courses of treatment may be recommended based on the individual's condition and the severity of their symptoms. Your specialist may discuss several methods with you and help you decide on the best one. They will also likely recommend certain lifestyle changes such as increasing water intake to flush out the bacteria. Pain medication may be prescribed to help alleviate discomfort while the use of a heating pad may also be suggested to help relieve any abdominal or back pain. Our goal at Gleneagles Hospitals is to help you get back on track with your lifestyle and activities. Treatment options such as those listed below depend on the individuals condition and health history.
Kidney Stones

Treatment depends on the type of stone and the cause.

For small stones, drinking water, taking pain relief or medication known as an alpha blocker to relax the muscles in your ureter, can help you pass the kidney stone without further invasive treatment.

For larger stones or stones that cause symptoms, treatment options include:

  • Using sound waves to break up the stones into tiny pieces which then pass in your urine in a 40 to 50 minutes procedure called extracorporeal shock wave lithotripsy (ESWL).
  • Surgery (percutaneous nephrolithotomy) to remove large stones in the kidney, using small instruments inserted through a small incision in your back.
  • Using a scope passed through your ureter and bladder to remove stones trapped in the ureter or kidney.

Urinary Incontinence

Treatment depends on the type, severity and the cause.

Acute urinary incontinence caused by kidney stone, infections or medication side effects often clears out when the root-cause problem is treated. Other urinary incontinence treatment options include:  

  • Conservative management such as Biofeedback, electrical stimulation and simple Kegel exercise
  • Continence devices, like buking substances (collagen or artificial substance) and pessary (semi-rigid ring) to help reposition and stabilise the bladder and urethra
  • Surgical treatment such as insertion of thin tube into the bladder (catheterisation) for those whose bladder fails to empty completely, placement of a pubo-vaginal sling (“hammock”) beneath the bladder to provide support, placement of an artificial sphincter to prevent urine leakage or sutures to stabilise the bladder
  • Medication

Subject to patient’s conditions, a combination of these therapies may be needed, and treatment is tailored to meet individual needs.

Erectile Dysfunction

Treatment depends on the cause and general health of the patients. There are different treatment options available:

  • Oral medication is usually the first line of treatment. It is effective in about 80% of patients but it may not be suitable for everybody as the medication can interact with some prescription medications which the patient may be taking.
  • Injection therapy is the second line of treatment if oral medications are unsuccessful. A specific drug can be self-injected by the patient into the shaft of the penis to achieve an erection.
  • External suction devices are used to pull blood into the penis to achieve and maintain an erection for intercourse.
  • Penile implant surgery which involves placing a prosthetic device for some patients to artificially create an erection

Benign Prostatic Hyperplasia (BPH)

Treatment depends on age, severity of BPH, and patient’s general health.

The treatment options include:

  • Drug treatment
  • Laser vaporisation for patients with smaller prostate glands
  • Surgical treatment to remove the parts of the swollen prostate that are pressing against the urethra
  • Simply wait and observe if symptoms are less severe

Prostate Cancer

Despite the name, it is a relatively common condition and grows slowly, contained within the prostate in its earlier stages. Most men with this form of cancer may even live for many years without exhibiting any issues.

However, if the tumour begins to spread beyond the prostate it may cause blockages in the surrounding tissues resulting in these symptoms:

- Increased frequency of urination at night
- Difficulty starting or stopping streams
- Incontinence during laughter, coughs and sneezes
- Pinful sensation during urination or ejculation
- Blood in urine or semen

Bladder Cancer

This condition typically occurs when cells in the bladder begin growing quickly and out of control. When enough of these cells develop, they form a tumour which can potentially spread to other parts of the body. Typically, the cancers begins in the urothelium, the innermost lining of the bladder. When it spreads it often first attacks the lymph nodes, liver or lungs.

Symptoms may include:

- Blood in urine
- Loss of appetite followed by weight loss
- Frequent than usual urination
- Pain during urination
- Feeling the urge to urinate even if the bladder isn't full
- Lower back pain on one side
- Weakened urine stream
- Fatigue and weakness

Urinary Tract Infection

A urinalysis, which involves testing the urine for signs of infection will be performed.

Urinary tract infections are often treated with antibiotics. The length of treatment is dependent upon the severity of symptoms. There are other methods which may be used in conjunction with antibiotic treatment to relieve pain, such as

  • Consumption of probiotics
  • Pain medications
  • Increasing fluid intake
  • Applying heat
  • Avoiding substances that irritate the bladder, such as coffee and spicy foods.

A three-day course of antibiotics is usually sufficient in eliminating the infection for urinary tract infection in patients who are otherwise healthy. If the infection has spread to the kidneys, a longer course of antibiotics may be necessary.

Our Specialists

Dr. Wong Teck Boon
Specialty
Urology
Location
Gleneagles Hospital Kota Kinabalu

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